It’s a law that helped give rise to the Tea Party, spurred a Re-publican takeover of Congress and has been the subject of GOP-backed legal challenges that have gone all the way to the U.S. Supreme Court.
President Barack Obama’s health care reforms — commonly known as Obamacare — have roiled state and national politics for more than five years. Opposition to Obamacare has become a defining issue for Republicans, a test of how true party members are to conservative values.
So perhaps it was inevitable that a Senate plan to expand subsi-dized health insurance coverage for the state’s poor, an Obamacare-inspired concept, would divide a Republican-dominated Florida Legislature and cause the most heated legislative battle in decades.
“That’s the way to make it a bumper sticker issue, calling it Obamacare,” said state Sen. Don Gaetz, R-Niceville.
Senators now find themselves at odds with the leadership of the state House and the governor. And in Gaetz’s particular case, he’s waging philosophical warfare against his own son, state Rep. Matt Gaetz.
“Gaetz family dinners have been tense,” Matt Gaetz said.
The problem for all of the Republicans is that Florida faces a major health care funding dilemma.
The federal money tied to coverage expansion would help make up for other federal health care dollars that are drying up. Whether or not to accept it has spurred a debate that many in the Florida GOP would rather not have.
That debate continues this week as lawmakers kick off a special legislative session.
Tensions are high after the issue sparked a legislative meltdown earlier this year.
A bill brought forward in the Republican-controlled Senate that included a proposal to expand Medicaid — the federal health insur-ance program for the poor — led the House to take the unprece-dented step of ending Florida’s annual 60-day legislative session three days early.
Don Gaetz said he and at least some fellow Senate Republicans would never have supported an expansion of Medicaid, even the short-term expansion proposed in the original Senate bill. But the House adjourned, he said, before amendments could be made.
Coming into the special session, the Senate has offered a dif-ferent proposal for expanding health care coverage.
The Florida Health Insurance Affordability Exchange, or FHIX — is being held up as a free-market approach that does not simply offer a handout.
The bill requires those who receive the health insurance vouch-ers to pay small monthly premiums and be working or in school.
“Some 820,000 working poor are not insured in Florida, and when they get sick they go to the emergency room,” Don Gaetz said. “When they do that their health care costs are shifted to us, small businesses and workers.”
Senators say the revised proposal doesn’t expand Medicaid but provides subsidies to help individuals shop around and choose among private health plans on the federal insurance exchange set up under Obamacare.
“I’m opposed to the expansion of Medicaid. I think we should provide some coverage options and make people work for them,” Don Gaetz said.
The Senators hope their brethren in the House will find their second plan more palatable. Matt Gaetz said FHIX still looks to him like a plan to expand Medicaid.
“To call it by another name, I think, would be inaccurate,” he said.
He argues the way the federal act is designed, those who would be eligible for draw down dollars must meet “every Medicaid requirement.”
“If it walks like a duck and quacks like a duck ….,” he said.
Senate leaders say they are ratcheting down the drama surround-ing the coverage expansion issue by no longer tying it to passing a state budget. They’re saying now the health care debate and budget debate can move on “parallel” tracks.
“You could have a scenario where no health care bills get done and you do a budget and go home,” said Senate President Andy Gardiner, R-Orlando.
That makes the possibility of a state government shutdown — a prospect Scott has been warning about – seem remote.
Legislative logjam
All the passion and momentum within the GOP continues to be on the side of expansion opponents. Senators have little leverage unless they are willing to force a shutdown.
“It’s going to be an uphill battle because the governor’s dug in,” Don Gaetz said.
Some of the fiscal urgency that initially drove the Senate has been removed since the regular session adjourned in April. Federal officials announced a preliminary offer to provide a portion of the health care funds that were in doubt for next year.
But the Obama administration also made it clear that it plans to continue tapering down Florida’s $2.1 billion low-income pool — a program that reimburses hospitals for charity care — in the coming years, leaving the state with a growing budget hole.
For that reason, senators argue that coverage expansion should remain on the table. Extending health insurance coverage to more than 800,000 low-income Floridians who currently do not qualify for premium subsidies under Obamacare could significantly reduce the need for charity care.
The governor and House Speaker Steve Crisafulli remain skeptical of the Senate plan. Crisafulli said it would be ineffective. Scott said it will “inevitably raise taxes in order to implement Obamacare and grow government.”
Senators say they would like to at least test the waters in the House and have the issue debated. The elder Gaetz said debate is important if anything is to be accomplished.
“For the House to get its issues considered by the Senate they’re going to have to take a few steps in our direction,” Don Gaetz said. “Both sides need to step towards the middle.”
He said the governor could be the biggest obstacle lawmakers face in getting meaningful health care legislation accomplished.
Don Gaetz said the governor has lately become an advocating a proposal through which well managed hospitals would share revenues with hospitals that are struggling and/or poorly managed.
No one in either chamber of the Florida Legislature is voicing support for that idea, Don Gaetz said.
“It’s really a strange proposal from a man who made millions buying and selling hospitals,” he said. “Maybe he’s being generous and intends for his proposal to be retroactive, and he’s willing to cut a check.”
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Gov. Rick Scott’s views on expanding the Medicaid health insurance program for the poor have shifted over the years. A summary of his positions:
l A former hospital company executive, Scott got his start in politics as a critic of government-run health care, forming a group called Conservatives for Patients Rights to oppose President Barack Obama’s health care reforms.
After becoming governor in 2010, he continued to criticize the reforms and express opposition to expanding Medicaid, one of Obama’s strategies for achieving universal coverage.
l Following Obama’s re-election and in the run-up to Scott’s own re-election bid in 2013, the governor changed course and spoke in favor of accepting the Medicaid expansion money.
Scott acknowledged that a repeal of Obama’s health care law seemed unlikely and said “our options are either having Floridians pay to fund this program in other states while denying health care to our citizens — or — using federal funding to help some of the poorest in our state with the Medicaid program.”
Scott reflected on the “struggles” his mother faced “to get my little brother the care he needed with very little money” and said: “I cannot, in good conscience, deny the uninsured access to care.”
l With the Florida Senate now pushing to draw down Medicaid expansion money and use it to subsidize the purchase of private health insurance plans for more than 800,000 Floridians, Scott, said to be considering a U.S. Senate bid, again reversed himself and now opposes taking the money.
Scott made his position on Medicaid expansion clear earlier this month, saying: “I’m not going to support it. It’s not a program that has worked.”
Last week, after the Senate revised its plan, Scott remained critical. “The Senate’s plan to expand Medicaid under Obamacare will cost Florida taxpayers $5 billion over 10 years,” he said, adding it will: “Inevitably raise taxes in order to implement Obamacare and grow government.”
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